World Journal of Research and Review (WJRR) ISSN:2455-3956, Volume-8, Issue-1, January 2019 Pages 01-03

The Effect of Breastfeeding on The Uterine Involution Post Partum Mothers

Rini Amelia, Masrul, Roza Sriyanti

 the influence of the oxytocin hormone which can increase Abstract—Background: The aim of the study determine the uterine contractions [3]. effect of breastfeeding on the uterine involution post partum The risk of postpartum complications is 3.5 times higher in mothers. Methods: The study was conducted using a cohort women who do not initiate early breastfeeding in the first 24 design. The study was conducted at Independent of hours of labor and are reduced by 7 days after giving birth Padang Panjang City, West Sumatera Province, Indonesia from November to December 2017. The population in this study was other than that the risk of neonatal death is four times higher spontaneous postpartum mother treated at Independent in children given other than breast milk [4]. Midwives who did and did not initiate early breastfeeding The coverage of exclusive breastfeeding in the world is within 1 hour after baby born and followed by breastfeeding seen by region, known to reach 25% in Central Africa, 32% in babies with breast milk for 7 days with a sample size of 42 Latin America and 30% in East Asia, 47% in South Asia, and people in two groups. Sampling technique with consecutive 46% in developing countries. Overall, less than 40 percent of sampling. Measurement of fundal height using caliper . Test the normality of data by Shapiro-Wilk test and children under the age of six are given exclusive hypothesis test using paired t test. A two-tailed P-value of <0.05 breastfeeding [5]. While coverage of early breastfeeding was considered statistically significant. Results: The result of initiation practices in the world was 42% in the period statistical test of independent T test was obtained p = 0,000 (p 2010-2015. The prevalence of early breastfeeding initiation value <0,05) it can be concluded that there is difference of in Indonesia is still lower at 49.3% [1]. In 2013 there was a fundal height day 1, 3 and 7 in breastfeeding and decrease in the percentage of mothers who carried out early non-breastfeeding group. The result of this research can be concluded that there is the effect of breastfeeding mother to breastfeeding initiation at 34.5% [1]. This figure is still very postpartum uterine involution (p value <0.05) Conclusion: The low when compared to other countries in Southeast Asian conclusion of this study confirmed there was an effect of countries such as Myanmar (76%), Thailand (50%), and the breastfeeding on the uterine involution post partum mothers. Philippines (54%) [5,6]. The aim of the study determine the effect of breastfeeding Index Terms—breastfeeding, uterine involution, post partum on the uterine involution post partum mothers.

II. MATERIALS AND METHODS I. INTRODUCTION Data from Ministry of Health Republic of Indonesia A. Study Design and Research Sample complicating puerperium is one of the causes of maternal The study was conducted using a cohort design. The study death by 8% [1]. Activities that are of concern in the was conducted at Independent Midwives of Padang Panjang are the administration of early City, West Sumatera Province, Indonesia from November to initiation of breastfeeding within 1 hour after birth and December 2017. The population in this study was ensuring uterine involution runs normally. Early spontaneous postpartum mother treated at Independent initiation of breastfeeding is a process of breastfeeding the Midwives who did and did not initiate early breastfeeding baby immediately after birth for 1 hour. Early within 1 hour after baby born and followed by breastfeeding initiation of breastfeeding is one of the factors that affect babies with breast milk for 7 days with a sample size of 42 uterine involution because stimulation occurs when breastfeeding and the release of hormones include oxytocin people in two groups. Sampling technique with consecutive which functions in addition to stimulating contractions of the sampling. smooth muscles of the breast, also causing contraction and B. Operational Definitions retraction of the uterine muscles. This will suppress blood The variables of this study included independent variable is vessels which result in reduced blood supply to the uterine. breastfeeding and dependent variable is uterine involution This process helps to reduce the site or place of implantation post partum mothers. of the and reduce bleeding [2]. Mothers who initiate early breastfeeding will accelerate uterine involution due to C. Data Collection Technique This study was approved by the Ethical Committee of Medical Faculty, Universitas Andalas with registration Rini Amelia Master of Program, Faculty of Medicine number 511/KEP/FK/2017. Early initiation of breastfeeding Universitas Andalas, Padang City, Indonesia within 1 hour after baby born and followed by breastfeeding Masrul, Department of Nutrition, Faculty of Medicine Universitas babies with breast milk for 7 days. Measurement of fundal Andalas, Padang City, Indonesia. Roza Sriyanti, Department of Obstetric and Gynaecology, Faculty of height using caliper pelvimetry with procedures after early Medicine Universitas Andalas, Padang City, Indonesia.

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Correlation of Fat Consumption and Lipid Profile for Telomere Length of Minangkabau Ethnicity Men, in West Sumatera, Indonesia initiation of breastfeeding,. Measurements of fundal height were carried out by researchers assisted by accompanying Table 3: The effect of breastfeeding on the uterine involution researchers (midwives). To avoid the occurrence of bias in post partum mothers measuring the height of the uterine fundus, it was carried out Uterine Mean ± SD ∆ Mean p Value by 2 people, namely the researcher and the accompanying Involution researcher who conducted it simultaneously. If there are Day 1 (cm) 10.76 ± 1.06 2.21 0.000* differences in measurements> 20%, the measurement of Day 3 (cm) 8.55 ± 0.91 fundal heigh is repeated. Day 1 (cm) 10.76 ± 1.06 D. Data Analysis 6.48 0.000* Day 7 (cm) 4.28 ± 0.53 The quantitative variables were recorded as Mean±SD, median and percentage. Test the normality of data by Table 3 showed fundal height of uterine involution on day Shapiro-Wilk test and hypothesis test using paired t test. A 1-3 is 2.21 cm and day 1-7 is 6.48 cm. There was statistically two-tailed P-value of <0.05 was considered statistically significant breastfeeding on the uterine involution post significant. A two-tailed P-value of <0.05 was considered statistically significant. Data were analyzed using the Stata partum mothers (p < 0.05). version 14.2 (Stata Corporation). Estimated Marginal Means of MEASURE_1

III. RESULTS Characteristics of respondents (Table 1).

Table 1: Characteristics of respondents 10 Characteristics Breastfeeding Not Breastfeeding (n=21) (n=21) Age (years) 28.33 ± 4.12 27.52 ± 3.87 Parity 2.24 ± 0.70 2.10 ± 1.09 8

Table 1 showed age of respondents in breastfeeding group 28.33 ± 4.12 years and 27.52 ± 3.87 in not breastfeeding group. Parity of breastfeeding group 2.24 ± 0.70 and 2.10 ± 6

1.09 in not breastfeeding group. Estimated Marginal Means Marginal Estimated Table 2: Mean difference of fundal height between breastfeeding and not breasfeeding group Group Breastfeeding Not 4 Fundal p (Mean ± SD) Breastfeeding TFU h-1 TFU h-3 TFY h-7 Height value (Mean ± SD) TFU Day 1 (cm) 10.76 ± 1,06 13.46 ± 0,97 0.000 Day 3 (cm) 8.55 ± 0,91 11.64 ± 0,64 0.000 Figure 1: Mean of fundal height on breastfeeding mothers Day 7 (cm) 4.28 ± 0,53 7.64 ± 0,78 0.000 ∆ Day 1-3 2.21 1.82 0.001 Figure 1 showed there was a decrease in the mean of ∆ Day 3-7 4.27 4.00 0.005 fundal on breastfeeding mothers who breastfeeding on day ∆ Day 1-7 6.48 5.82 0.001 1-7.

Table 2 showed the mean fundal height the breastfeeding group was found to decline on days 1, 3 and 7. The decrease IV. DISCUSSION in fundal height on days 1-3 is 2.21 cm and on days 3-7 is The result showed there was an effect of breastfeeding on 4.27 cm. While on days 1-7 there are 6.47 cm. The mean the uterine involution post partum mothers. The fundal height fundal height in the non-breastfeeding group on days 1-3 is reduction process is fast if on the first day of the fundal height 1.82 cm and on days 3-7 is 4 cm whereas on day 1-7 is 5.82 > 1 finger naked below the center and on the 3rd day > 3 cm. There is mean difference of fundal height between fingers below the center. It is said to be normal if on the first breastfeeding and not breasfeeding group (p < 0.05). day fundal height 1 finger is below the center, and on the 3rd day fundal height 3 fingers below the center. But it is said to be slow if on first day fundal height <1 finger below the center, and on the 3rd day fundal height <3 finger below the center. In this study, fundal height decrease in breastfeeding mothers found a decrease in fundal height on days 1 and 3 of

2.21 and was in the fast category and until day 7 there was a

decrease of 6.48 cm.

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Previous studies known early breastfeeding has an effect V. CONCLUSION on uterine involution [3]. Another study there is a relationship The conclusion of this study confirmed there was an effect between early breastfeeding initiation and an increase in of breastfeeding on the uterine involution post partum postpartum maternal recovery (p value <0.05) [8]. mothers. Giving breast milk or breastfeeding should be done immediately after the newborn baby, this can foster a ACKNOWLEDGMENT relationship or bond between mother and baby and can provide a warm feeling by laying and attaching to the We would like to thank all respondents who participated in mother's skin and covering it, breastfeeding is maximum this study. because this is very important whether the baby will get enough milk or not. This is realized by the role of the REFERENCES milk-making hormone, including the hormone prolactin in [1] Ministry of Health Republic of Indonesia. Overview of maternal the blood circulation of the mother will decrease after one health in Indonesia. Data and Information Center, Jakarta, 2013. hour of labor caused by the release of the placenta. In an effort [2] Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. Breastfeeding and Health Outcomes for the Mother-Infant Dyad. to maintain prolactin, baby suction will provide stimulation Pediatr Clin North Am. 2013; 60: 31–48. to the pituitary to expel the oxytocin hormone. The oxytocin [3] Kristoschek JH, Moreira de Sa RA, Silva FCD, Vellarde GC. hormone works to stimulate smooth muscle to squeeze the Ultrasonographic Evaluation of Uterine Involution in the Early milk that is in the alveoli, lobes and ducts containing breast Puerperium. Rev Bras Ginecol Obstet. 2017; 39:149-154. [4] Edmond KM, Zandoh C, Quigley MA, Amenga-Etego milk released through the nipple [7,8]. S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation In this condition the baby's suction will help expel the increases risk of neonatal mortality. Pediatrics. 2006; 117:e380-6. milk. The process is when the baby sucks the smooth muscles [5] World Health Organization. Medical Record Manual A Guide For of the nipple aroused, this stimulation by the nerve is Developing Countries. World Health Organization, Geneva, 2015 [6] NindreaRD, Aryandono T, Lazuardi L, Dwiprahasto I. Diagnostic transmitted to the brain. Then the brain instructs the back of accuracy of different machine learning algorithms for breast cancer the pituitary gland to expel the oxytocin hormone which is risk calculation: A meta-analysis. Asian Pac J Cancer Prev. 2018; 19: carried to the smooth muscles of the breast, so that the smooth 174-52. [7] Fuchs A-R, Romero R. Oxytocin secretion and human parturition: fulse muscles of the breast contract. With the contraction of these frequency and duration increase during spontaneous labor. American smooth muscles the milk is released, and in the cell occurs Journal of and Gynaecology. 2001; 165: 1515-23. breastfeeding production again. The oxytocin hormone not [8] Mc.Govern P, Dowd B, Gjerdingen D, Gross CR, Kenney S, Ukestad L only affects the smooth muscles of the breasts but also the et al. Postpartum Health of Employed Mothers 5 Weeks After . Ann Fam Med. 2006; 4: 159–167 smooth muscles of the so that the uterus contracts [9] Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. better, thus involution of the uterus faster and lochea's Breastfeeding and Health Outcomes for the Mother-Infant Dyad. expenditure more smoothly. That is why in mothers who Pediatr Clin North Am. 2012; 60: 31–48. breastfeed involution of the uterus lasts faster than not [10] Harahap WA, Sudji IR, Nindrea RD. BRCA1 promoter methylation and clinicopathological characteristics in sporadic breast cancer breastfeeding [9, 10]. patients in Indonesia. Asian Pac J Cancer Prev. 2018; 19: 2643-9. Based on the phenomenon that the researchers met in the field there are factors that support and inhibit exclusive breastfeeding. Supporting factors include the mother's support from health workers and families, especially in this case is husband. While the inhibiting factors include the mistaken perception of the mother that she feels she has not yet existed, the mother assumes that the new baby will be breastfed if she and her baby are clean (bathing), and the mother feels exhausted after the labor process and is just going to breastfeed if the condition is right completely recovered. In addition, the researchers also found a lack of cooperation between mother and family and health workers who helped deliver. If seen of course, every medical action still needs approval from the family, before exclusive breastfeeding is carried out, it still needs to be consulted with the family about the benefits and importance of breastfeeding, but the researchers found several conditions where the family refused advice from officers to carry out exclusive breastfeeding, so the officers could not force implementing exclusive breastfeeding for babies. Implementation of early breastfeeding as possible by putting the baby on the mother's breast will benefit the mother and baby. Stroke baby's head on mother's breast, touch baby's hand when breastfeeding, baby on mother's nipple will stimulate expulsion of hormone oxytocin which will support to uterine contractions and accelerate the process of uterine involution. .

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